The Use of Medicines in the U.S. 2022
Usage and spending trends and outlook to 2026
Institute Report
Apr 21, 2022

Web Summary

While the nation’s primary healthcare focus remains on the COVID-19 pandemic as we move through the third year of its disruptive effects and the death toll approaches 1 million, other important dynamics are playing out with respect to the utilization of health services, the use of prescription medicines, and the associated spending levels, including patient out-of-pocket costs. Understanding these elements of the health system and how they may evolve over the next five years remains critical to decision-makers and stakeholders – including patients.

This annual trend report - The Use of Medicines in the U.S. 2022 – is intended to provide a grounding in relevant information across a range of issues with both short- and long-term implications. It includes the Health Services Utilization Index, which tracks a range of healthcare activities that affect the use of medicines.

Spending and growth drivers reflect the significant differences in levels of spending by stakeholders as discounts and rebates distort these trends even as the most impactful driver has been the amount spent on COVID-19 vaccines and therapeutics. An overview of patient out-of-pocket costs shows that while most patients’ costs are falling, a small proportion have high costs which impact their use of medicines with implications for their health outcomes.

The outlook for the years ahead includes the expected end of the pandemic as well as significant shifts in drivers of usage and spending overall and in key therapy areas.

Key findings

  • Spending on U.S. medicines rose 12% in 2021 due primarily to COVID-19 vaccines and therapies
  • Despite an increase in overall spending, costs per prescription on average are flat or slightly declining
  • Prescription drug use reached a record 194Bn daily doses in 2021 as new prescription starts for both chronic and acute care recovered from the slowdown recorded in 2020
  • Health services utilization returned to pre-pandemic levels by the end of 2021 but has yet to make up for the pandemic-induced backlog in missed patient visits, screenings and diagnostics, elective procedures, and new prescription starts
  • Spending on medicines is expected to return to pre-pandemic growth trend lines by 2023

Other Findings

  • The cumulative Health Services Utilization Index across the pandemic (Q2 2020-Q4 2021) remains at 90 despite a recovery in recent quarters to pre-pandemic levels, indicating both concerning gaps in preventive and treatment services that have yet to be addressed and avoided interactions with the healthcare system due to declines in routine illnesses (e.g., flu).
  • Doctor visits – including face-to-face and telehealth - were the least impacted during the pandemic and have rebounded to higher than pre-pandemic levels. Despite significant increases in visits toward the end of 2021, the cumulative index across the pandemic remains 3% below pre-pandemic levels
  • Screening and diagnostic tests have largely rebounded to pre-pandemic levels; however the cumulative deficit is 5% below baseline, with 41% of this deficit occurring between March and May of 2020.
  • The use of medicines in the U.S. — based on defined daily doses — has grown 9.6% over the last five years to nearly 194Bn days of therapy in both retail and non-retail settings in 2021.
  • Retail drugs currently represent 86% of medicine use in the U.S. with only 14% of use in non-retail settings, which has been declining since 2017.
  • The use of drugs dispensed from retail pharmacies has continued to grow on average 2.3% annually reaching 166.5Bn days of therapy in 2021.
  • Over the past five years, spending at list prices [Wholesaler Acquisition Cost (WAC)] has increased from $581Bn to $776Bn — an average of 5.9% per year.
  • Payer net spending has increased from $463Bn to $586Bn over five years at a compound annual growth rate of 4.8%.
  • Spending at manufacturer net prices, including all products, are estimated to have grown an average of 4.6% over five years and 12.1% from 2020 to 2021, including $26Bn of growth from COVID-19 vaccines and therapeutics.
  • Patient out-of-pocket costs rose $4Bn in 2021 to a total of $79Bn and remain a significant burden for a relatively small part of the population even as average costs per prescription are flat or slightly declining.
  • This growth was driven by retail out-of-pocket costs, which grew 4.8% in 2021 following two years of declines and lower growth but are slightly down from retail costs in 2018.
  • Non-retail out-of-pocket costs have remained relatively stable over the last four years but have grown 16% since 2016.
  • While the short-term impact from COVID-19 in 2020 and 2021 has been significant, the long-term impact on growth trends is more muted.
  • Including estimates of higher spending growth from COVID-19 vaccines and disruptions from the pandemic, the five-year compound annual growth rate (CAGR) to 2026 is unchanged compared to the pre-COVID-19 outlook, and the forecasts differ by only 0.2% - within the range of uncertainty of 2-5%.
  • The market growth dynamics include the contribution in 2021 of $29Bn in spending on COVID-19 vaccines and therapeutics, which moderates to only $4-5Bn per year afterward, masking the stability of the rest of the market – especially in 2022.
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